Provider Demographics
NPI:1518016294
Name:BUCKNER SMILEY DENTAL PLLC
Entity Type:Organization
Organization Name:BUCKNER SMILEY DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYNH
Authorized Official - Middle Name:T
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:469-767-0796
Mailing Address - Street 1:PO BOX 451807
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75045-1807
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4801 S BUCKNER BLVD
Practice Address - Street 2:STE 800
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-2373
Practice Address - Country:US
Practice Address - Phone:972-616-0060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX198871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty